title: Medical bankruptcy in Massachusetts: has health reform made a difference?
abstract: BACKGROUND
  Massachusetts' recent health reform has decreased the number of uninsured, but no study has examined medical bankruptcy rates before and after the reform was implemented.
  
  
  METHODS
  In 2009, we surveyed 199 Massachusetts bankruptcy filers regarding medical antecedents of their financial collapse using the same questions as in a 2007 survey of 2314 debtors nationwide, including 44 in Massachusetts. We designated bankruptcies as "medical" based on debtors' stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.
  
  
  RESULTS
  In 2009, illness and medical bills contributed to 52.9% of Massachusetts bankruptcies, versus 59.3% of the bankruptcies in the state in 2007 (P=.44) and 62.1% nationally in 2007 (P<.02). Between 2007 and 2009, total bankruptcy filings in Massachusetts increased 51%, an increase that was somewhat less than the national norm. (The Massachusetts increase was lower than in 54 of the 93 other bankruptcy districts.) Overall, the total number of medical bankruptcies in Massachusetts increased by more than one third during that period. In 2009, 89% of debtors and all their dependents had health insurance at the time of filing, whereas one quarter of bankrupt families had experienced a recent lapse in coverage.
  
  
  CONCLUSIONS
  Massachusetts' health reform has not decreased the number of medical bankruptcies, although the medical bankruptcy rate in the state was lower than the national rate both before and after the reform.
authors.affiliation: City University of New York School of Public Health, New York, 10010, USA. Dhimmels@hunter.cuny.edu
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
authors.forename: Deborah
authors.initials: D
authors.lastname: Thorne
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
mesh_terms: D016361:Bankruptcy / Q000191:economics; D017028:Caregivers; D018166:Health Care Reform / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D008404:Massachusetts; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014478:Unemployment; D014481:United States